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Li C, Feng H, Wang X, Wang Y. The influencing mechanism of iliac vein stent implantation for hemodynamics at the bifurcation. Comput Methods Biomech Biomed Engin 2023; 26:1452-1461. [PMID: 36082958 DOI: 10.1080/10255842.2022.2120352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/08/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
In the intervention with stent implantation for iliac vein compression syndrome (IVCS), it remains unclear about the influencing mechanism of the structure and implantation position of the stent for the hemodynamics of the affected site. In this paper, an iliac vein model was established. Besides, the computational fluid dynamics (CFD) was utilized to analyze the time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) in a sine period after stent implantation based on the three different implantation positions of two iliac vein stents (the left branch outlet, contralateral disturbed flow and main iliac vein). The influence of the structure and implantation position of the stent on blood flow was revealed. These findings were verified by the particle image velocimetry (PIV) experiment. The results indicated that the maximum blood flow velocity of the iliac vein decreased after the stent implantation. Among the three positions, the influence of stent implantation on the iliac vein blood flow was the least when the stent implantation was performed at the left branch outlet; the influence of stent implantation on the iliac vein blood flow was the greatest when the stent implantation was performed at the contralateral disturbed flow. Moreover, there was little influence of Venastent implantation on the blood flow. These results could provide a scientific foundation for implantation treatment and stent design related to IVCS.
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Affiliation(s)
- Changsheng Li
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Haiquan Feng
- College of Mechanical Engineering, Inner Mongolia University of Technology, Hohhot, P.R. China
| | - Xiaotian Wang
- The First Affiliated Hospital of University of Science and Technology of China, Hefei, P.R. China
| | - Yonggang Wang
- Suzhou Venmed Technology Co., Ltd, Suzhou, P.R. China
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Mazhar J, Ekström K, Kozor R, Grieve SM, Nepper-Christensen L, Ahtarovski KA, Kelbæk H, Høfsten DE, Køber L, Vejlstrup N, Vernon ST, Engstrøm T, Lønborg J, Figtree GA. Cardiovascular magnetic resonance characteristics and clinical outcomes of patients with ST-elevation myocardial infarction and no standard modifiable risk factors–A DANAMI-3 substudy. Front Cardiovasc Med 2022; 9:945815. [PMID: 35990971 PMCID: PMC9383416 DOI: 10.3389/fcvm.2022.945815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionA higher 30-day mortality has been observed in patients with first-presentation ST elevation myocardial infarction (STEMI) who have no standard modifiable cardiovascular risk factors (SMuRFs), i. e., diabetes, hypertension, hyperlipidemia, and current smoker. In this study, we evaluate the clinical outcomes and CMR imaging characteristics of patients with and without SMuRFs who presented with first-presentation STEMI.MethodsPatients from the Third DANish Study of Acute Treatment of Patients With ST-Segment Elevation Myocardial Infarction (DANAMI-3) with first-presentation STEMI were classified into those with no SMuRFs vs. those with at least one SMuRF.ResultsWe identified 2,046 patients; 283 (14%) SMuRFless and 1,763 (86%) had >0 SMuRF. SMuRFless patients were older (66 vs. 61 years, p < 0.001) with more males (84 vs. 74%, p < 0.001), more likely to have left anterior descending artery (LAD) as the culprit artery (50 vs. 42%, p = 0.009), and poor pre-PCI (percutaneous coronary intervention) TIMI (thrombolysis in myocardial infarction) flow ≤1 (78 vs. 64%; p < 0.001). There was no difference in all-cause mortality, non-fatal reinfarction, or hospitalization for heart failure at 30 days or at long-term follow-up. CMR imaging was performed on 726 patients. SMuRFless patients had larger acute infarct size (17 vs. 13%, p = 0.04) and a smaller myocardial salvage index (42 vs. 50%, p = 0.02). These differences were attenuated when the higher LAD predominance and/or TIMI 0-1 flow were included in the model.ConclusionDespite no difference in 30-day mortality, SMuRFless patients had a larger infarct size and a smaller myocardial salvage index following first-presentation STEMI. This association was mediated by a larger proportion of LAD culprits and poor TIMI flow pre-PCI.Clinical trial registrationclinicaltrials.gov, unique identifier: NCT01435408 (DANAMI 3-iPOST and DANAMI 3-DEFER) and NCT01960933 (DANAMI 3-PRIMULTI).
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Affiliation(s)
- Jawad Mazhar
- Kolling Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Kathrine Ekström
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rebecca Kozor
- Kolling Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Lars Nepper-Christensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kiril A. Ahtarovski
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Dan E. Høfsten
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stephen T. Vernon
- Kolling Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Lund University Hospital, Lund, Sweden
| | - Jacob Lønborg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gemma A. Figtree
- Kolling Research Institute, University of Sydney, Sydney, NSW, Australia
- *Correspondence: Gemma A. Figtree
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Figtree GA, Redfors B, Kozor R, Vernon ST, Grieve SM, Mazhar J, Thiele H, Patel MR, Udelson JE, Selker HP, Ohman EM, Maehara A, Karmpaliotis D, Eitel I, Granger CB, Ben-Yehuda O, Stone GW, Kosmidou I. Clinical Outcomes in Patients With ST-Segment Elevation MI and No Standard Modifiable Cardiovascular Risk Factors. JACC Cardiovasc Interv 2022; 15:1167-1175. [PMID: 35680197 DOI: 10.1016/j.jcin.2022.03.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The author recently reported ∼50% excess early mortality in patients with first-presentation ST-segment elevation myocardial infarction (STEMI) without standard modifiable cardiovascular risk factors (SMuRFs); the cause of this is not clear. OBJECTIVES The aim of this study was to examine differences in infarct characteristics and clinical outcomes in patients with versus without SMuRFs (dyslipidemia, hypertension, diabetes mellitus, and smoking). METHODS Individual-level data were pooled from 10 randomized percutaneous intervention (PCI) trials in which infarct size was measured within 1 month by either cardiac magnetic resonance or technetium-99m sestamibi single-photon emission computed tomography imaging. First-presentation STEMI was classified into 2 groups according to the presence or absence of at least 1 SMuRF. RESULTS Among 2,862 patients, 524 (18.3%) were SMuRF-less. After adjusting for study effect, SMuRF-less patients had more frequent poor pre-PCI flow Thrombolysis In Myocardial Infarction 0/1 compared with patients with at least 1 SMuRF (72.0% vs 64.1%; OR: 1.35; 95% CI: 1.08-1.70). There were no independent associations between the presence or absence of SMuRFs at baseline and infarct size (estimate = -0.35; 95% CI: -1.93 to 1.23), left ventricular ejection fraction (estimate = -0.06; 95% CI: -1.33 to 1.20), or mortality at 30 days (HR: 0.46; 95% CI: 0.19-1.07) and 1 year (HR: 0.74; 95% CI: 0.43-1.29). CONCLUSIONS First-presentation STEMI patients with no identifiable baseline SMuRFs had a higher risk of Thrombolysis In Myocardial Infarction flow grade 0/1 pre-PCI. However, after adjustment, there were no significant associations between SMuRF-less status and infarct size, left ventricle ejection fraction, or mortality.
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Affiliation(s)
- Gemma A Figtree
- Kolling Research Institute, University of Sydney, Sydney, Australia; Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Bjorn Redfors
- Clinical Trials Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rebecca Kozor
- Kolling Research Institute, University of Sydney, Sydney, Australia
| | - Stephen T Vernon
- Kolling Research Institute, University of Sydney, Sydney, Australia; Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia. https://twitter.com/steve_vern
| | - Stuart M Grieve
- Imaging and Phenotyping Laboratory, Charles Perkins Centre and Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jawad Mazhar
- Kolling Research Institute, University of Sydney, Sydney, Australia
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Manesh R Patel
- Division of Cardiology, Duke University Hospital, Durham, North Carolina, USA
| | - James E Udelson
- Division of Cardiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Harry P Selker
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - E Magnus Ohman
- Division of Cardiology, Duke University Hospital, Durham, North Carolina, USA
| | | | - Dmitri Karmpaliotis
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Ingo Eitel
- University Heart Center Lübeck and the German Center for Cardiovascular Research, Lübeck, Germany
| | | | - Ori Ben-Yehuda
- Clinical Trials Center, New York, New York, USA; Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Gregg W Stone
- Clinical Trials Center, New York, New York, USA; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/GreggWStone
| | - Ioanna Kosmidou
- Clinical Trials Center, New York, New York, USA; Division of Cardiology, Memorial Sloan Kettering Cancer Center and Weill-Cornell College of Medicine, New York, New York, USA. https://twitter.com/IKosmidou
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